PBR code of conduct will cut fraud and disputes

18 Aug 05
Health care providers face penalties if they do not comply with a new code of conduct on payment by results, the Department of Health has said.

19 August 2005

Health care providers face penalties if they do not comply with a new code of conduct on payment by results, the Department of Health has said.

There is considerable concern that PBR could destabilise the finances of NHS organisations and the department hopes the code will minimise this by avoiding disputes and 'gaming' of the new system.

Last week, five Labour MPs wrote to Health Secretary Patricia Hewitt to protest at the tariff being paid to the Wrightington, Wigan and Leigh NHS Trust in Lancashire for orthopaedic operations under PBR.

The Healthcare Commission reported three weeks ago that a string of trusts were running unacceptable deficits, and some, including the Royal Free Hospital in Hampstead, and Peterborough and Stamford, are closing wards to save money.

The DoH has launched a three-month consultation on the code, saying that there should be an emphasis on trust and collaboration in the new payments system, which links providers' income directly to the work being done. The code would apply to NHS and non-NHS providers.

Health minister Lord Warner said: 'It is essential that there is a commitment across the NHS and its partner bodies to a collaborative approach so that patients receive the maximum benefit from our reforms to make the NHS patient-led.

'In order to build an NHS-wide consensus, we need further input from as many people as possible. This code of conduct should play a part in creating a fair and transparent system that rewards organisations for good performance and ensures that the patient comes first.'

Despite the emphasis on partnership, the department warned that there would be penalties for those who did not adhere to the code and for organisations that deliberately 'upcoded' or charged for more expensive treatment than had been given.

A separate assurance framework is being developed. It will set out the steps to be taken to monitor and audit invoices to detect fraud, as well as the penalties and details of who will enforce such action.

The NHS Confederation welcomed the proposed code. Its own discussion paper on PBR said: 'There is now an urgent need to develop appropriate regulatory and market management frameworks, including the code of behaviour, data validation and assurance, policing and sanctions.

'There will be a need for a national overview, including benchmarking, pattern analysis, selective random and planned audits by a national expert body.'

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